呼伦贝尔地区MRSA耐药谱及分子流行病学特征分析  

Study on the drug resistance and molecular epidemiological characteristics of MRSA in Hulunbuir

作　　者：孙刚[1] 孙辉[1] 杜彦丹[1] 李寅雁[1] 李英智[1] 董占柱 佟力军 彭博 SUN Gang;SUN Hui;DU Yandan;LI Yinyan;LI Yingzhi;DONG Zhanzhu;TONG Lijun;PENG Bo(Department of Clinical Laboratory,Inner Mongolia Forestry General Hospital,the Second Clinical Medical School of Inner Mongolia University for Nationalities,Yakeshi 022150,Inner Mongolia,China;Department of Clinical Laboratory,the Affiliated Hospital of Inner Mongolia University for Nationalities,Tongliao 028000,Inner Mongolia,China)

机构地区：[1]内蒙古林业总医院内蒙古民族大学第二临床医学院检验科,内蒙古牙克石022150 [2]内蒙古民族大学附属医院检验科,内蒙古通辽028000

出　　处：《检验医学》2021年第6期600-603,共4页Laboratory Medicine

基　　金：内蒙古自治区自然科学基金面上项目(2015MS0873)。

摘　　要：目的了解内蒙古呼伦贝尔地区耐甲氧西林金黄色葡萄球菌(MRSA)主要流行株,并探讨不同基因型与耐药谱的关系,明确MRSA的起源、传播和流行特征,寻找有效控制MRSA感染的途径,延缓万古霉素不敏感菌株的出现。方法收集2012年1月—2017年6月内蒙古呼伦贝尔地区5家医院非重复MRSA临床分离株55株。采用Vitek 2 Compact自动化鉴定药敏系统进行菌种鉴定和体外药物敏感性分析。通过多位点序列分型(MLST)联合葡萄球菌染色体mec基因盒(SCCmec)基因分型对MRSA进行基因分型。结果SCCmec基因分型共检出6个基因型,以Ⅱ型为主(58.18%),其中包括2个未明确分型菌株;MLST共检出10个基因型,其中有2个可能为新的型别,居前3位的型别分别为ST59(50.91%)、ST72(10.91%)和ST239(10.91%)。ST59-MRSA-SCCmecⅡ的检出率为38.18%。ST59型对环丙沙星和庆大霉素的耐药率较低(3.57%),未检出左氧氟沙星、莫西沙星、利福平耐药菌株;ST239型对四环素、环丙沙星、左氧氟沙星、莫西沙星、庆大霉素、利福平的耐药率均为83.33%;ST72型除对红霉素、克林霉素高水平耐药外,未检出对其他抗菌药物耐药菌株。ST239型对红霉素和克林霉素的耐药率(66.67%)低于ST59型(85.71%)和ST72型(83.33%)。结论呼伦贝尔地区MRSA流行菌株以ST59型为主,其次是ST72型和ST239型,优势型别是ST59-MRSA-SCCmecⅡ型。ST59型和ST72型对环丙沙星、庆大霉素、左氧氟沙星、莫西沙星、利福平敏感率高,ST239型对其耐药率高。Objective To determine the main epidemic isolate of methicillin-resistant Staphylococcus aureus(MRSA)in Hulunbuir,to study the correlation between gene types and resistance spectra,and to define the origin,transmission and epidemiological characteristics of MRSA.The results may help to find solutions to control MRSA infection and delay the emergence of vancomycin insensitive isolate.Methods Totally,55 non-duplicate MRSA isolates were collected from 5 hospitals from January 2012 to June 2017 in Hulunbuir.Vitek 2 Compact automatic identification system was used to identify the isolates and to perform antimicrobial susceptibility testing.Multilocus sequence typing(MLST)combined staphylococcal cassette chromosome mec(SCCmec)typing were used to determine the gene types of MRSA.Results A total of 6 types,including 2 un-typed isolates,were detected in the 55 MRSA isolates,and the predominant type was SCCmec typeⅡ(58.18%).Totally,10 types,including 2 new types,were identified in MLST,and the predominant type was ST59(50.91%),followed by ST72(10.91%)and ST239(10.91%).Combining SCCmec typing and MLST,the ST59-MRSA-SCCmecⅡwas the predominant type(38.18%).The resistance rate of ST59 to ciprofloxacin and gentamicin was low(3.57%),and no levofloxacin,moxifloxacin and rifampicin resistant isolates were determind;The resistance rates of ST239 to tetracycline,ciprofloxacin,levofloxacin,moxifloxacin,gentamicin and rifampicin were 83.33%.ST72 isolates were not resistant to other antibiotics except erythromycin and clindamycin.The resistance rate of erythromycin and clindamycin in ST239(66.67%)was lower than those in ST59(85.71%)and ST72(83.33%).Conclusions The predominant type is ST59,followed by ST72 and ST239.Combining with SCCmec typing,the predominant isolate is ST59-MRSA-SCCmecⅡin Hulunbuir.ST59 is sensitive to ciprofloxacin,gentamicin,levofloxacin,moxifloxacin and rifampin,while ST239 shows a different resistance spectrum and has a high drug resistance rate.

关 键 词：耐甲氧西林金黄色葡萄球菌 基因分型 耐药性 呼伦贝尔地区 

分 类 号：R378.1[医药卫生—病原生物学]